U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

This is a general description of the plan changes. This page is not an official statement of benefits. For that, go to the Benefits descriptions in the Plan Brochure. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

• Under Standard Option, your share of the non-Postal premium will increase by 7.1% for Self Only or 7.3% for Self and Family.

• Under Basic Option, your share of the non-Postal premium will increase by 8.6% for Self Only or 8.2% for Self and Family.

• Under Standard Option, we now provide benefits in full for outpatient pharmacotherapy (medication management) you receive from Preferred providers after you pay a $15 copayment. Previously, we paid benefits for outpatient pharmacotherapy given by Preferred providers at 90% of our allowance after your Standard Option calendar year deductible had been met. [See Sections 5(a) and 5(e).]

• Under Standard Option, we now provide benefits in full for anesthesia and assistant surgeon services you receive from Preferred providers as part of your covered maternity care. Previously, we paid benefits for these services when performed by Preferred providers at 90% of our allowance after your Standard Option calendar year deductible had been met. [See Section 5(a).]

• Under Standard Option, we now provide benefits for emergency admissions to Non-member facilities at 100% of the Plan allowance after the patient's $300 per admission copayment. Previously, benefits were provided at 70% of the Plan allowance after the $300 per admission copayment. [See Section 5(c).]

• Under Standard Option, we now provide benefits for covered ambulance transport services not related to accidental injury at 90% of the Plan allowance, not subject to the calendar year deductible. Previously, benefits were subject to the calendar year deductible and were paid at either 90% or 75% of the Plan allowance, depending on the contracting status of the ambulance provider. You remain responsible for any difference between our allowance and the billed amount when you use Non-participating/Non-member ambulance providers. [See Sections 5(c) and 5(d).]

• Under Standard Option, office visits made to your primary/family doctor for the diagnosis or treatment of a mental health or substance abuse condition (not including therapy) no longer count as a visit toward the requirement to obtain an approved treatment plan from your therapist prior to your ninth outpatient therapy visit (the treatment plan requirement). Previously, we counted visits to your primary/family doctor toward the treatment plan requirement.

• Under Standard Option, we no longer require prior approval for partial hospitalization or intensive outpatient treatment provided by Non-preferred providers. [See Section 3.]

• Under Basic Option, we now provide benefits in full for covered preventive care that your children receive from Preferred providers. Previously, members paid a $20 or $30 copayment for this type of care. [See Section 5(a).]

• We now provide benefits for bone density tests when performed for screening purposes. [See Section 5(a).]

• We now provide Maternity care benefits for tocolytic therapy and related services when provided and billed by a home infusion therapy company or a home health care agency. [See Section 5(a).]

• We now provide benefits for covered services performed by physician assistants. [See Section 3.]

• We now provide benefits for autologous bone marrow or peripheral blood stem cell transplants performed in specific, comparative trials funded by the National Institutes of Health (NIH) for systemic sclerosis, systemic lupus erythematosus, and multiple sclerosis. [See Section 5(b).]

• All members must contact us at the customer service number listed on the back of their ID card before obtaining services at Blue Quality Centers for Transplant (BQCT). This requirement applies even if you have Medicare Part A or another group health insurance policy as your primary payer. [See Section 3.]

• We changed a number of the procedure codes for covered dental services to reflect changes made by the American Dental Association (ADA). [See Section 5(h).]

• We changed the address for FEP Enrollment Services. [See Section 3.]

• We changed the address for filing overseas claims. [See Section 5(i).]

• We no longer provide benefits for acupuncture performed by a physical therapist.